[takinxanax]

My husband completed a neuropsychological exam a couple of months ago and had poor results from the memory test. He scored about 10%. I didn't like the psychologist that tested him so I don't want to work with him. I'm not sure what this all means. My marriage has been very difficult, to say the least, and I don't know what to do next. Is memory loss always from TBI? How is he coping? It seems as if he is confused a lot.

[Lightrail11]

First off welcome to NeuroTalk. Sounds like there are a couple of dynamics at work here.

Regarding the neuropsychological exam, most of the time these are delivered by a clinical neuropsychologist using some subset of standardized tests for memory as well as other cognative functions. If he scored in the 10th percentile this is compared with baseline scores from people with a similar age, education and so forth. The fact that you didn’t like this psychologist is to a certain extent irrelevant, assuming she or he followed accepted protocol. The neuropsychologist’s role at this point would be to recommend therapy treatments, which would likely include work with a speech and/or occupational therapists; the neuropsychologist isn’t normally the one that does the follow up therapy.

Per your question “is memory loss always from TBI”, there can be other causes of memory deficits, but since you have posted here I will assume your husband has had some form of TBI? TBI can cause memory problems, as I know from personal experience. The fact that he is “confused a lot” is also consistent with TBI patients.

Regarding your “marriage has been difficult” comment, is this related to your husband’s TBI? If so, please consider that many TBI patients make tremendous progress. My wife was my best ally and helped push me to continue my progress. If the difficulties existed before, then only you can answer what your role in his recovery should be.

If you provide more background on when the injury happened, the severity of his TBI, and treatments to date, forum members will be better able to share related experiences and suggestions.

Best to you both.

[Mark in Idaho]

takinxanax,

Again, Welcome to NT. I have memory functions measured in the 5 to 12% range, too. As lightrail said, there is more to this diagnosis than a simple number. You husband may have confusion for a number of reasons that may have little to do with his memory function.

For many of us, our symptoms have remained at a limited level for years. This does not need to be a death sentence to living a full life. You both need to learn the many work-arounds and accommodations for living with memory and cognitive limitations.

Tell us more about his injury, his diagnosis, his treatments and his current living environment/work/family. Improvement in function is helped when the whole family is involved.

It will help if you read the Vitamins.... thread. It has good information and some links to online resources such as the YouTube "You Look Great" video series.

Please feel free to ask or tell us anything. We are a very supportive community.

My best to you both.

[takinxanax]

Thank you Lightrail and Mark for your answers! Before we were married, 20 years ago, I was unaware of his problems but did question him about his spelling..asking if he had dyslexia and he said no. Over the years I've had trouble communicating with him. I thought he was being a jerk on purpose and we ended up in marriage counseling 2 years ago. The counselor immediately said he should have a neuropshchological test. The final results were the memory issues, and a learning disability. A couple of things the tester, Ralph, said that scared me were: "The only reason you can he can do his job is that he has been doing it for so long and has it memorized" and "He doesn't understand the meaning of things". My husband seems to have some kind of auditory processing problem because he often does not answer the question like he heard it right. But that didn't really show up in the test. I have found out he had two significan head injuries as a kid and one severe car accident in his 20's. He was also a serious alcoholic with 5 DWI's and 3 times through treatment but he has been sober for 25 years.
His life is very simplified and routine. He defers to me a lot. He lacks empathy and laughs at inappropriate things. His social life consists of work and his AA group and many of his male friends have fallen by the wayside. He stays at work as late as possible and everything we have planned in our life together has fallen apart: children, a business, a cabin, etc. He can't seem to see things through. He hasn't accepted that he has issues because he told Ralph he can fix our marriage problems himself. We don't have much family and I am isolated with him and can't take another weekend couped up. I think he needs a lot of help and I'm not qualified or patient and don't know if I even love him anymore. It's a lot!

[Mark in Idaho]

takinxanax,

First, I hope you are not using xanax to help you deal with this struggle. But I digress.

On the communication struggle, he may struggle to process too many concepts in a sentence. This can be immediate memory related. It is better to ask questions with a single issue. For example, Can you go to the store and get me some flour and baking powder? This has three concepts. Instead, Can you go to the store for me ? he replies "yes" You follow up, I have a list of things for you to get. You give him a written list.

If he has to make too many decisions to answer the question or complete the task, he may overload and freeze up.

His lack of empathy is called 'flat affect.' It is not uncommon. It takes work to learn to express emotion when it does not flow naturally. The laughing at inappropriate times is called emotional lability. That part of the brain gets its wires crossed. I bet this happens most during stressful situations. It is very easy for the PCS brain to get its wires crossed during stressful situations.

His ability to work is due to it being an 'over-learned skill.' It has been memorized into so many different locations in the brain that he has access to those memories even without having to think. This is like a well trodden path through the woods. The ground has been so compacted for so many years that nothing grows there to hide the trail.

An example: I moved to Idaho in July 2000 and suffered my life changing concussion in Jan 2001. I had already memorized all of the main streets in 2 counties and was quite able to find my way about town by January 2001.

After the concussion, I lost all that memory. It was not amnesia. I just could not remember the order and placement of the streets. I could fly back to San Jose for work and know the streets there like the back of my hand. I still can. San Jose streets were an over-learned skill. The Idaho streets were not learned well enough.

He can still over-learn things but it will take repetition upon repetition.

He may have a verbal processing dysfunction. I have a verbal processing dysfunction. I can usually understand complex words but I can rarely recall them to use them as I speak. But, if someone is speaking in very complex sentences, I get lost very easily. So, it will be important to understand how his mind works so you can communicate in ways he will understand.

A family counselor taught us a simple skill. One person makes a comment and the listener has to repeat back what they heard. If you can get him to work with you on this, you may be able to learn how to better communicate. Most of the burden will likely fall on you since you have more adaptive skills. His adaptive skills are likely very limited.

btw, Congratulations on being married for 20 years, especially to someone with his history. I know what my wife and kids put up with before we understood what was going on in my brain. My injuries date back to childhood (1965) with many head injuries since then causing further struggles.

Please tell us more but help us by putting a double paragraph space every 5 lines. Some of us struggle to follow to the next line in long paragraphs.

So, I assume you two are in your late 40's or 50's. There are changes to an injured brain that start to manifest in the 40's. Think of it as menopause for the brain. Prior struggles tend to get magnified.

There are plenty of other symptoms you likely have not told us about. This is normal. Between the members here, we have seen it all.

My best to you.

[Lightrail11]

Originally Posted by takinxanax

He had two significan head injuries as a kid and one severe car accident in his 20's.

He can't seem to see things through. He hasn't accepted that he has issues because he told Ralph he can fix our marriage problems himself. We don't have much family and I am isolated with him and can't take another weekend couped up. I think he needs a lot of help and I'm not qualified or patient and don't know if I even love him anymore. It's a lot!

Thank you for you transparency and explanations. I’m not a doctor or psychologist, but with the concussions happening many years ago he probably has made cognitive and emotional adjustments over those many years that may be difficult to break or change.

In AA (I am a well-qualified AA member also) step 1 is acceptance. Like recovery from alcohol or pretty much anything, the desire to change has to be there. After my TBI I didn’t want to do the prescribed therapies, but I did them because I realized my brain was injured and I wanted to get better. At this point it sounds as if he hasn’t gotten to where he sees the need to change. Indeed, with his history of alcoholism and the brain injuries he may not have the capacity to see the need to change.

Have you considered counseling for yourself? I sense some conflict in your story, and it may helpful for you to talk through that conflict with a professional. Or a free option I might suggest is to try al-anon, where you can talk through your feelings with others that can share their non-judgemental support. Even though he has been sober for 25 years it sounds like he is struggling with acceptance of his other deficits that are impacting your relationship. You sound like a caring but frustrated spouse and you deserve to live a happy life.

I wish you the best.

[takinxanax]

I do go to Al Anon and have for several years. I think your opinion that his old injuries will be hard to change now is right on. He has not accepted that he has problems. I am conflicted because I don't want to get divorced but I can't go on like this. I also worry and care about his future which seems kind of bleak. I have a lot of support and do take care of myself.
He has other issues besides the TBI; dyslexia, alcohol, low self-esteem. I do hope he gets some kind of help. Thank you for your well thought out and written response it has helped me tremendously and best of luck to you.

[Mark in Idaho]

Have you tried finding a Brain Injury Support Group ? Your state BIAA affiliate will likely have a list. Some have good support systems for caregivers and family.

[takinxanax]

Mark, all I can say is wow!! You are an expert and hit the nail on the head (what a terrible pun!) This is very detailed and has quite specific ways to deal with him. I am going to print that last post and refer to it.

The problem I am having now is that he hasn't accepted he has problems and still holds his ground and that I am burned out. I have considered being kind of a caregiver support person in his life since we share a beautiful home and cabin and our lives are totally intertwined. I fear for him if I leave because he will be lost and revert to compensating which only get him in deeper doo-doo.

I need to be totally honest here and please be understanding. I know this is very personal but I don't know who else to talk to! I have dated an old friend on the side that I really care for.

I have this crazy idea that I can enjoy and deserve my new friend while I try to help my husband and also work on possibly getting out of this marriage which has worn me down to a confused and hopeless 56 year old woman.

I also feel angry that he wasn't honest with me (husband) and that nobody in his family was honest either. Actually, they covered up the real person and were cheerleaders; cheering him on and encouraging and rewarding and praising him. My mom told me that at our wedding rehearsal dinner a woman from husband's hometown came up to her and said "takinxanax" will take care of him! She thought that was a weird comment, but now we know why she said it.

You might say you can't advise me on the personal issues-but I would accept your views as yours and not take it as advice.

What is the best thing I can do for him given this situation? He seems like he is spiraling downward-depression and hopelessness. Some of this is because I am being honest that I'm not sure I want to stay.

Yes I do take Xanax! It is monitored by my doctor and I am grateful for it. I also have a glass of wine at night to knock me out. But, I do a lot of other things to cope.

Again, Mark, you are amazing with your information and for taking time to share it. Ever soo grateful. Please keep writing if you have more to share and maybe I will change my moniker to "offxanax".

[takinxanax]

Mark here are some more symptoms:

Unrealistic anxiety about money. He claims that any expense over $1,000.00 sends him into a panic. Doesn't make eye contact with the person to whom he's speaking-makes eye contact with me or someone else. No personal time structure-makes coffee at night, falls asleep with doors unlocked and computer on his lap, loses track of time during projects. No future hopes and/or dreams. Refers to our friends like I've never met them or don't know them. Defers to me about almost everything. Seems to prefer simple, ritualistic existence. A lot of trouble reading, terrible spelling that is getting worse.

I did try a brain injury support group and suggested he go and that I would go with him....just got a blank look back from him!!

He does have a lot of good qualities and actually some genius skills. He is likable and funny. He really needs to be pushed and helped so his life doesn't get worse. If he loses his job...I fear it will all be downhill from there.

I went back to school a few years ago and got my Master's in Technical Writing and am on the upswing career-wise. I had a sneaking suspicion I would need it.